Exploring empathy and patient-centered communication behaviors of third-year medical students during a clinical skills examination

Patient Educ Couns. 2025 Apr 14;137:108786. doi: 10.1016/j.pec.2025.108786. Online ahead of print.

ABSTRACT

A previous study of third-year medical students’ empathy during a clinical skills assessment found that SPs rated female students higher than males, and male Black/African-Americans received the lowest empathy scores. Our objective was to analyze students’ patient-centered communication behaviors (PCCBs) to better understand those reported gender and racial/ethnic differences in empathy scores.

METHODS: We examined 63 videos from the parent study, using discourse and content analysis to identify PCCBs during standardized patient (SP) encounters. Then, we determined which PCCBs significantly correlated with SP empathy ratings. Finally, we examined whether those significant PCCBs differed across third-year medical students’ gender and race/ethnicity.

RESULTS: We identified 18 PCCBs, six of which significantly correlated with SP empathy ratings. Generally, women tended to use patient-centered communication than men, while Black/African American men used less than Asian/Pacific Islander or white men.

CONCLUSION: In this exploratory, multiple methods study, we analyzed student discourse to better understand the reported gender and racial/ethnic differences in SP empathy scores. We found suggestions of gender and racial differences in behaviors related to patient-centered communication that need to be confirmed in larger, better-powered studies.

PRACTICE IMPLICATIONS: If our findings are corroborated, understanding gender and race/ethnicity differences in PCCBs may help medical educators teach students patient-centered communication (PCC) in a more diverse, culturally situated way. Beneficial actions would include developing faculty to teach PCC with a multi-cultural emphasis and recruiting more minority faculty in our medical schools to model effective communication and empathy skills. In addition, the PCCBs we identified through discourse analysis in this study can provide educators with a tool for teaching doctor-patient communication. Educators can review students’ video encounters to provide specific and actionable feedback to promote PCC and empathy.

PMID:40279679 | DOI:10.1016/j.pec.2025.108786